Two outbreaks of Q fever were reported in the Netherlands in 2007 and 2008. The ongoing 2008 outbreak in the south-eastern part of the Netherlands is the largest community outbreak ever described, with 808 cases reported until August 2008. The changing epidemiology of Q fever is most likely related to intensive goat farming, and has important implications for the clinical care of patients in endemic areas. Treatment of community-acquired pneumonia has to take possible Q fever into account, and the high incidence of Q fever endocarditis and other manifestations of chronic Q fever require a specific diagnostic and therapeutic approach.